If you know someone caring for and elderly or infirm person, please take an hour or day out of your week to help them. The caregiver is often the person at greatest risk for the next fall, stroke, heart attack, or bout of depression.

Amplify’d from www.whitehouse.gov

Caring for Caregivers

Posted by Terrell McSweeny on January 28, 2010 at 06:35 PM EST

This week the Middle Class Task Force unveiled a series of initiatives in the President's FY 11 budget that are aimed at helping families with soaring child care costs, balancing work with caring for elderly relatives or people with disabilities, paying for college, and saving for retirement.  These are costs that – along with health care – have risen dramatically for families at a time when their incomes haven't.   Some people call this "squeeze" because of the pressure these costs put on family budgets.  But for many families it just seems like it is impossible to get ahead.

This is particularly true for the so-called "sandwich generation" – people who are caring for children (or grandchildren or adult children who are struggling financially) and their parents.   The Vice President often speaks very personally about his experience caring for his parents and in-laws.  And almost all of us know someone who has juggled caring for a parent or relative who can’t get along completely on their own.  Millions of Americans provide unpaid care to aging relatives – including approximately 23 million caregivers with jobs and 12 million who are also caring for their own children.   That's why the Middle Class Task Force’s "squeeze" initiative includes help for family caregivers.

These caregivers play a vital role in helping seniors stay in their communities or at home.  But too often they don’t have the support they need to balance caregiving with work and family responsibilities.  As Elinor Ginzler of AARP put it:

"AARP is grateful that the Middle Class Task Force has drawn attention  to an issue that is deeply important to our members—the critical role of family caregivers and what we should be doing to help them.  Approximately 65 million Americans provide care to a loved one, giving more than $375 billion worth of unpaid care each year—often at their own financial and emotional expense.  Increasing support to these invaluable individuals would be an important step to help those who do so much to help others."

The nearly $103 million investment proposed by the Middle Class Task Force will support more respite care, counseling, training, referrals, and adult day care.  As Sandy Markwood, CEO of National Association for Area Agencies on Aging explained:

"Vice President Biden’s Middle Class Task Force’s recommendation to increase funding for the National Family Caregiver Support Program and Lifespan Respite, along with strengthening supportive services through Title III-B of the Older Americans Act, represents a huge investment in community-based programs that support the independence of older Americans and their caregivers. These funds will enable them to access and get the critical services that they need while avoiding unnecessary and more expensive institutional care or spending down to Medicaid.  We applaud the work that has been done by the Administration that serves to strengthen long term living options through home and community-based services."

The extra funding proposed by the Task Force will allow nearly 200,000 additional caregivers to be served and 3 million more hours of respite care to be provided.  It adds funding to programs that provide transportation help, adult day care, and in-home services including aides to help bathe and cook.  Some have said these things are modest.  And, to some extent, they are. But sometimes it is these small things that add up to make all the difference.

Eric Hall, President and Chief Executive Officer of the Alzheimers Foundation of America is well aware of the vital help these services give families:

"Family caregivers who struggle each day with practical and financial challenges have been anxiously waiting for this issue to be brought to the national stage and for relief in their own homes and communities. For these families, assistance at any level can help delay nursing home placement and enhance caregiver well being. The proposed initiatives represent a welcome change in direction, from minimal or flatlined funding to amounts that will make a difference for hundreds of thousands of American families."

And here’s what Gail Hunt, CEO of the National Alliance for Caregiving who represents family caregivers said:

"The National Alliance for Caregiving is proud to support the Middle Class Task Force and their efforts to support family caregivers. This is a wonderful addition to the National Family Caregiver Support Program and it is a perfect way to recognize these caregivers who on average spend 18 hours a week providing care.  The funding for transportation, adult day care and other services under Title III b will also help family caregivers by assisting the older adult they are caring for. We are grateful to the Middle Class Task Force for bringing much needed public awareness to the family caregiver."

The caregiver initiative won’t magically alleviate all the strain on caregivers and their families – but it is an important first step toward providing more support for families and caregivers and the vital services they are performing.

Terrell McSweeny is Domestic Policy Advisor to the Vice President Read more at www.whitehouse.gov

You don't have to be elderly to be forgetful, but a poor memory doesn't mean dementia either.

Amplify’d from health.yahoo.net

Licensed from Worried About Your Memory? 5 Signs It's Not Serious

By Paula Spencer, Caring.com Tue, Nov 30, 2010

It's natural to feel a little uneasy when you forget something, knowing that Alzheimer's disease now afflicts 5.3 million Americans, many still in their 40s and 50s. It's scary, sure. But many bouts of memory loss are simply the result of much more benign situations.

How can you tell the difference? The following five situations point toward normal, age-related memory loss. The best rule of thumb: "If you're concerned, see a specialist," says psychiatrist Gary Small, director of the UCLA Center on Aging and author of several books about memory and cognition, including The Naked Lady Who Stood on Her Head. An evaluation can rule out certain potential causes and often identify reversible ones. (See also Worried About Memory Loss? 5 Signs It's Serious.)

It's probably not serious if: Lapses don't interfere with everyday life.

Everybody forgets stuff. The movie title on the tip of your tongue. The name of the dad on the soccer field. The occasional appointment or lunch date. What the heck you just came in the room to get.

Slowed recall of information from time to time is normal, caused by the naturally aging brain and other lifestyle factors (like trying to cram too many tasks into one day). What's not normal: When memory impairment interferes with your ability to get through the day. Everyday activities tend to rely on many rote steps and require you to remember basic sequences -- which the healthy brain isn't apt to forget.

So it's a reassuring sign if, despite occasional lapses, you can still work, prepare meals, dress yourself, manage your checkbook, pursue hobbies, and read 900-page novels or pursue your other usual hobbies as well as ever without needing help.

Brain training helps

It's probably not serious if: You see an improvement after "brain training."

Dozens of "brain fitness" products now exist, promising to strengthen our synapses and buffer our brainpower. Do they work? So far, there's no evidence that brain games or cognitive training can reverse the memory loss associated with Alzheimer's-related decline, according to a National Institutes of Health panel convened in 2010. But the jury is still out on whether there's a protective effect on healthy brains.

"Our brains naturally compensate for memory loss, and we can help our brains compensate more by learning memory techniques and cognitive techniques," psychiatrist Gary Small says. "If you do some of these techniques and see an improvement, that's a good sign."

Dementia is not so much a problem of retrieving old memories as it is an inability to form new ones. If you can still learn new things, you're forming new memories.

Among the available brain-strengtheners: Software you run on your home computer, classes offered by memory centers, cognitive therapy directed by trained therapists, and do-it-yourself books offering brain teasers and other games.

You've got new meds

It's probably not serious if: You've just started a new medication.

It's always a good idea to consider what else is going on in your life before you get too worried about a fuzzy brain. Drug side effects happen to be one of the more common, unexpected causes of memory trouble.

In fact, among older adults, who are often taking multiple prescriptions and then have an increased risk of dangerous interactions, the problem is so common that some geriatricians believe that any new symptom should be considered a medication side effect until proven otherwise.

Medications known to cause short-term memory loss include antianxiety drugs and sedatives (Xanax, Valium, Ambien), heartburn drugs (Tagamet, Pepcid), incontinence drugs (Detrol or Ditropan), cholesterol drugs (Lipitor) and some statins for high cholesterol, and antidepressants. A complete list numbers in the high dozens; always check with your doctor or pharmacist, especially if you've recently started a new prescription or have had the dosage changed.

You're the only one who's worried

It's probably not serious if: Nobody else seems to notice anything's amiss.

It's true that people might be noticing you're slipping but not saying anything to protect your feelings. But usually, there's a lot of family friction around memory loss that predates a diagnosis, says University of Wisconsin geriatric psychiatrist Ken Robbins. You find yourself in arguments over who neglected to do something, missed appointments, forgotten messages, or lost drivers. Family members may criticize or complain about mistakes before there's a diagnosis of something serious like dementia.

Eventually, this adds up to relatives often making a dementia diagnosis informally themselves, and being right. A 2010 study at the University of Washington School of Medicine in St. Louis found that family and friends tend to be able to spot the early warning signs of Alzheimer's disease even better than traditional screening tests and high-tech measures. They notice symptoms like repetitive stories or questions, social apathy, and changes in the person's ability to independently conduct everyday life (work, cooking, money management).

But if you're all still just teasing and joking over occasional slips -- think of Nora Ephron titling her new book I Remember Nothing -- odds are good nobody's alarmed yet.

You're stressed

It's probably not serious if: You're forgetful when stressed, sleep deprived, or multitasking.

Before you blame the worker (you), consider the workload. A stressed brain is not the same as a demented one.

Doing two or more things at once taxes the brain. No surprise there. Neuroimaging studies have shown that you're not really attending to several things at once. You're switching your attention from one to another, which means when you're attending to one thing, you're not really attending to the others in bursts lasting milliseconds. Result: short-term memory loss.

The challenge is especially hard if you're using the same part of the brain -- for example, using language centers to talk on the phone, read onscreen, and type at the same time.

Insufficient sleep is another common brain stressor, because that's when the brain processes and organizes memories for later retrieval. General stress, too, affects memory when increased cortisol production temporarily interferes with normal brain cell communication

People with early dementia, on the other hand, tend to forget regardless of whether they're sleeping well or poorly, busy or slow at work, stressed or unstressed. Read more at health.yahoo.net

Seasonal Affective Disorder also hits the elderly hard. Please keep a look out for senior citizens this season and look into neighbors helping elderly neighbors programs.

Amplify’d from thewordworm.wordpress.com

How To Cope With Winter Blues

Around 50% of the adult population find that, the onset of winter gets them down. The nights are drawing in and there’s a nip in the air, one in four of us will succumb to the winter blues or full-blown Seasonal Affective Disorder (SAD).  Here are some tips that can help get you through the winter months smiling. Don’t Fight The Winter As the temperature and levels of light drop, it is normal to feel a bit low in mood. We do need this climatic downtime, accept winter as an essential part of the year, which allows you to slow down, reflect and reconnect with what’s important. Be Prepared For Winter Kit yourself out for winter, properly insulate yourself with thermals, invest in a pair of sturdy wellies or snow boots and a good waterproof jacket to keep out the rain. Get The Right Tools For Winter Don’t let the first frost catch you scratching your windscreen with a credit card! Invest in an ice scraper or a night ‘car cap’ that can be taken off in the morning.  Tired of using a feeble umbrella? Why not buy an award-winning ‘Senz’, a storm proof umbrella that can see off 70 mph, and also boasts an innovative shape to keep bottoms dry. Protect Your Hands Prevent painful chapped-skin by slathering on non-greasy hand cream, each time after washing your hands.  Fingers need to be kept warm when temperatures plummet. Leather is naturally water-repellent and keeps hands warmer than man-made fabrics and knitted gloves.  Look for soft Nappa leather to maintain dexterity and long cuffs to keep draughts out. Don’t Hibernate This Winter A reluctance to socialize is one of the consequences of Seasonal Affective Disorder (SAD).  As humans we are not programmed to hibernate like Hedgehogs, isolating yourself or hibernating will worsen a low mood. Try not to sleep in, this can disrupt your body clock and trigger headaches, by staying in bed you will be missing out on precious winter daylight.  We are programmed to sleep more in the winter so as to recharge our batteries. Try and get up at your usual time each day, but get more sleep by going to bed earlier. Fitness In Winter Try and embrace winter and keep yourself active and healthy, try a ‘Sno’ fit workout featuring snow board and ski moves.  Why not take up Zumba, a Latin inspired, dance base workout.  People who take part in Zumba swear it combats a low mood. Wake Up Smiling Try using a dawn simulator that floods your room with ‘daylight’. Studies have shown it boosts the body’s internal body clock, meaning you will wake up feeling alert.  Why not try a session in a real Sunlight Simulator Spa, clever lighting replicates full spectrum sunlight, with the harmful UV rays filtered out and infrared heat.  It claims to help beat SAD, reduce stress and boost energy and immunity. Train Your Brain Learn to think positively, by thinking hopeless, despairing thoughts; such as “I hate winter” your brain creates equally depressing chemicals.  Break this cycle by focusing on good things, the train being on time, the traffic lights staying green.  Positive thoughts help release a surge of positive hormones. Look Good And Feel Better This Winter Just because the sun has gone in, don’t abandon your good grooming habits.  Regular moisturising, waxing and pedicures, although hidden underneath opaque and woollies, will keep you feeling good. Eat Yourself Happy Many of us become deficient of vitamins during the winter.  Slice an avocado in your lunchtime sandwich and wash it down with a glass of milk, both are good sources of vitamin D, oily fish and eggs are also great sources.  Try not to lapse on your five a day, winter fruits and vegetables are delicious, cram as many of them into soups, casseroles and porridge, this will help your body and your mind. Keep It In Perspective Tell yourself often that this will pass, by Christmas the days are already beginning to get longer.  Get yourself some holiday brochures and start dreaming.   For further advice on winter blues or SAD contact your doctor or log on to: sada.org.uk Read more at thewordworm.wordpress.com

Especially important for seniors living at home without any kind of homecare or oversight by family members. Eat well, live well, be well!

Amplify’d from www.longtermcarelink.net

Vitamins and Mineral Supplements Are Important for Older People

Research has discovered that as we age, our diets and our need for dietary supplements become more.  Doctors are increasingly concerned about boosting the levels of vitamins and minerals that we need as we grow older.

mportant and they are required for all sorts of complex chemical reactions in our bodies.  Vitamins

As most people get older, they tend to eat less due to a loss of appetite.  As a result, many elderly individuals do not take in adequate amounts of vitamins and other nutrients as they did when they were younger.  Other factors that can affect appetite and the inadequate uptake of vital nutrients are medications, medical complications, certain disabilities, diabetes, changes in the digestive system and even the changes in our skin as we age.  One study estimates that one-third of the elderly are alarmingly low on important vitamins and minerals.  Another study indicates that two thirds of the elderly patients admitted to a hospital are mal-nourished, resulting in low levels of vital nutrients.  When a person is vitamin and mineral deficient, he or she is more susceptible to illness and infections.  It is estimated that deaths due to infections are ten times more likely in the elderly.

So what is a vitamin and why is it so essential to our bodies?  A vitamin is a molecule that our bodies need to carry out certain biological functions.  With only a few exceptions, we have no way to create vitamin molecules ourselves, so these vital building blocks must come in through food that we eat.  The human body is known to need at least 13 different vitamins.  We are able to store some of these for long periods of time in fat cells or in the liver -- such as vitamin A -- but most vitamins need to be replenished frequently.    Vitamins don't supply us with energy.  We need protein, carbohydrates, and fats for that.  What vitamins do is to help the carbohydrates, fats, and proteins release energy.  These vital compounds are very important and they are required for all sorts of complex chemical reactions in our bodies.  Vitamins are also needed to assist the enzymes that repair tissue and help with the production of cells.  Many studies show that vitamins and minerals can help or prevent some of the disorders or diseases related to aging.    There are two types of vitamins -- water soluble and fat soluble.  Water soluble vitamins are not stored in our systems.  They pass through us quickly.  In order to keep these nutrients in our bodies we have to consume them frequently.  Water soluble vitamins contribute to our health, energy and stamina.  This type of vitamin also helps in the function of over one hundred enzymes and chemical reactions that give our bodies energy.   Listed below are some of the well known water soluble vitamins and their benefits. Vitamin B5 – good for reducing swelling Vitamin B3 – reduces tissue swelling and helps increase blood flow. Vitamin B6 – also reduces swelling.  When combined with vitamin B12 in proper concentration has shown to reduce heart disease. Vitamin B12 – This is the most vital of the B's.   It aids in the formation of cells, myelin production, healthy nerves, and maintaining immune system and mental function. Vitamin C – Vitamin C helps in the formation of cartilage and bone.  Some studies have shown it may reduce the progression of osteoarthritis. Fat soluble vitamins are vitamins that stay in the body and are typically stored in the liver.  You can usually receive enough of these compounds by eating a well balanced diet.   Any condition that can interfere with the absorption of fat in the body like tuberculosis, cystic fibrosis, hypothyroidism, lactose intolerance, and many other diseases or disorders can cause deficiencies in these vitamins.  Before taking the daily recommended dose of fat soluble vitamins you must consult your doctor.  Overdosage of these substances can cause a toxic build-up.  Listed below are the major fat soluble vitamins. Vitamin A – Lungs, throat and mouth depend on vitamin A to retain moisture.   This compound is also important for your skin, bones, teeth, digestive system, urinary tract, eyes and aids in preventing skin disorders like acne, boils, and bumpy skin.  Some studies show that it may aid in slowing the aging process. Vitamin K – plays an important role in the clotting of blood.  Research has linked vitamin K to bone health. Vitamin D – is produced in the skin by exposure to the sun.  Deficiencies mostly occur in people living in northern latitudes where daylight is brief during winter months.  Changes in skin as we age can also cause poor production of vitamin D.   Studies show that  osteoporosis might progress faster in women with low levels of vitamin D.  This compound is essential in helping the body absorb calcium and in maintaining strong bones. Minerals Unlike vitamins, minerals are not manufactured by plants or animals.  Minerals form in the earth, and are absorbed by plants and found in animals that eat the plants.  Listed below are some of the essential minerals needed to maintain a healthy body. Iron – helps carry oxygen throughout the body.  Iron also helps the immune system ward off foreign entities. Calcium – Most women as they get older need calcium supplements to prevent bone loss that causes osteoporosis.  Calcium supplements will not do you any good if you do not have the right levels of vitamin D.  your body cannot absorb calcium without vitamin D. Zinc – Zinc deficiencies can affect skin, nerves, and the body’s immune system. It is important that you take vitamin and mineral supplements with food.  Fat soluble vitamins require fat ingestion to result in the best absorption.  It is best to take your supplements at the biggest meal of the day.  We use vitamins every day to support the processes our bodies use to maintain life.  Ongoing reduced levels of vitamins can make you weak and more vulnerable to disease.  Proper nutrition with vitamins and minerals is vital for seniors to maintain a healthy lifestyle.  Other health issues related to aging are discussed on the National Care Planning Council website at www.longtermcarelink.net. Read more at www.longtermcarelink.net

Sound advice for people of all ages.

Amplify’d from www.longtermcarelink.net

"Planning for Eldercare" Articles

Getting Your Affairs In Order August 9, 2010

If we had a crystal ball and could see into the future, we would not need to prepare ahead for end of life decisions.

James was 62 years old when a stroke made it impossible for him to communicate with his family. Neither his wife nor children knew anything about his financial or medical information. James had always taken care of things himself and left no written directives in his behalf. Besides having to locate important documents, the family was left to make their own decisions about James long term care.

The National Institute on Aging gives three simple, but important steps to putting your affairs in order:

“Put your important papers and copies of legal documents in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there's anything new to add.

Tell a trusted family member or friend where you put all your important papers. You don't need to tell this friend or family member about your personal affairs, but someone should know where you keep your papers in case of emergency. If you don't have a relative or friend you trust, ask a lawyer to help.

Give consent in advance for your doctor or lawyer to talk with your caregiver as needed. There may be questions about your care, a bill, or a health insurance claim. Without your consent, your caregiver may not be able to get needed information. You can give your okay in advance to Medicare, a credit card company, your bank, or your doctor. You may need to sign and return a form.” National Institute on Aging http://www.nia.nih.gov

Preparing Advance Directives or Living Will

Advance directives are legal documents that state the kind of medical care or end of life decisions you want made in your behalf. It is a way for you to communicate your wishes to family or health care professionals. Emergency response medical personnel cannot honor Advance directives or living wills. They are required to save and stabilize a person for transfer to a hospital or emergency facility. Once at the facility a physician will honor the directives.

The Living Will as part of your directives gives your consent or refusal for sustained medical treatment when you are not able to give it yourself. If this document is not in place then a family member or physician will decide such things as:

Resuscitation if breathing or heartbeat stops

Use of breathing machines

Use of feeding tubes

Medications or medical procedures

Advance Directives and Living Wills are legal throughout the United States; however, some states may not honor other states' directive documents. Be sure to check with the state you live in for their requirements.

Review your directives periodically. They do not expire, but your wishes may change. A new or revised Advanced Directive invalidates the old one. Be sure your family member or healthcare proxy has a current copy.

Choosing a Power of Attorney

General Power of Attorney - authorizes someone to handle your financial, banking and possibly real estate and government affairs as long as you remain competent.

Special Power of Attorney - authorizes someone you designate to handle certain things you cannot do yourself for a period of time.

Durable" Power of Attorney -The general, special and health care powers of attorney can all be made "durable" by adding certain text to the document. This means that the document will remain in effect or take effect if you become mentally incompetent.

Many people do not know the difference between a general and a durable power of attorney. A general power of attorney is a document by which you appoint a person to act as your agent.

Agents are authorized to make decisions for you, sign legal documents, etc. Many people are unaware that a General Power of Attorney is revoked when the person granting that power becomes incompetent or incapacitated.

It is the "Durable" Power of Attorney that allows for an agent to continue making decisions on your behalf no matter what happens to you. A responsible adult child of an aging parent would be given a "durable power of attorney" to act on behalf of the parent. This provides broader authority than just adding the child's name to bank accounts and documents.

You may choose to produce notarized power of attorney documents on your own. If your estate is large and real estate or business is included it is advised to secure a reliable attorney.

National Care Planning Council http://www.longtermcarelink.net/a2cfindattorney.htm Read more at www.longtermcarelink.net

It's no wonder that seniors want to age in place in their own homes.

Amplify’d from seattletimes.nwsource.com

Seniors embrace aging in place

Instead of selling their homes and moving into retirement villages, more aging Americans are modifying their homes to make them more user-friendly

By Jean Patteson

The Orlando Sentinel

The new catch phrase among homeowners is "aging in place."

Instead of selling their homes and moving into retirement villages or assisted-living quarters, a growing number of older Americans are modifying their homes to make them more user-friendly as they age.

The concept has caught on so successfully, it even has its own National Aging in Place Week, which falls on Oct. 11-16 this year.

"Aging in place is a near and dear subject," said Karen Kassik, president of Home Accessibilities, a residential design firm that focuses on building barrier-free homes.

The inspiration for the firm was Kassik's experience with her own mother, who moved into Kassik's newly remodeled home in Casselberry, Fla., while recovering from foot surgery in 2002. Thinking the visit would last only a few months, Kassik installed her mother in the master suite while she moved into the tiny guest bedroom. But it soon became apparent her mother would not be able to live alone again.

Kassik's 1,300-square-foot house, with its narrow doorways and awkward steps, was unsuited to someone struggling to get around with a walker. Rather than remodel a second time, Kassik decided to build a larger, more-accessible home in the same neighborhood.

"I designed it with wider door openings, a shower with no doors or steps, and a kitchen with more storage at waist level. My mother has complete access to anywhere inside and outside the house, and we both have our privacy," said Kassik.

"Going through that experience brought to light how many clients in their 50s and 60s could benefit from incorporating these kinds of features into their homes, whether they're building new or remodeling," she said.

Since launching Home Accessibilities in January, Kassik has discovered that many features benefiting the elderly also work for young children, from lever-style door handles to low-level storage in drawers rather than overhead cabinets. Instead of "aging-in-place homes," she uses the terms "multigenerational" or "universal" for the houses she designs.

Her interest in age-friendly homes also led her to help launch a local chapter of the National Aging in Place Council, a network of professionals from the private, public and nonprofit sectors who can help retirees plan for their housing needs. (For information, visit ageinplace.org)

The reasons for the aging-in-place trend are demographic, economic and cultural, said Jim Lucia, a home designer and general contractor with Lucia & Monday Architecture in Winter Park.

The baby boomers now reaching retirement age tend to be healthier and more independent than previous generations, and are not ready to give up homeownership when they retire. The weak economy means fewer Americans can afford the move into retirement facilities — even if they manage to sell their homes in this depressed market. And among some fast-growing ethnic groups, including Hispanic and Asian, it is traditional for older family members to share living quarters with the younger generations.

"We're doing more and more remodeling for couples who want to grow old in their own home. Or we're adding a suite onto the kids' home," said Lucia.

"People are living longer. Many of them don't want to be alone, or maintain a home alone. And as they age, family is becoming more important," he said. "I'm definitely doing more three-generation homes now than five years ago."

AGING-IN-PLACE FEATURES

Wider doors, hallways and toilets

Same-level transitions or ramps instead of steps

Roll-in showers with wide, doorless entries, grab bars, nonskid tiles, built-in seats and handheld shower units

Walk-in closets, casement windows, lever-style door handles

Waist-high kitchen appliances and storage drawers. Read more at seattletimes.nwsource.com

The elderly, disabled, and chronically ill are just the tip of the iceberg for who can benefit from home visits from doctors. For too long, medicine in the United States has focused of prescriptions instead of nutrition, lifestyle, and sincere, in-depth follow-up care.

Amplify’d from www.kaiserhealthnews.org

Living In A 'Medical Home'

How experiments in Vermont and other states are prompting calls for national improvement in care for the chronically ill.

Topics: Health Costs, Delivery of Care, Health Reform

By Susan Brink

LYNDONVILLE, Vt. -- When Rita Pinard learned she had diabetes three years ago, she never imagined she would end up in an ambitious experiment that has become part of the national health care debate.

Initially, she didn't think her diagnosis was all that bad. Her physician, Dr. Joyce Dobbertin, didn’t seem alarmed. "She gave me a spiel about losing weight and exercising and told me to come back in three months," says Pinard, 57, who promptly ignored the lifestyle advice.

But in January, when Pinard's blood sugar shot up, Dobbertin took a different approach. She turned her patient over to a nurse, a dietician and a diabetes educator who alternately encourage and nag Pinard to take steps to control her disease.

Pinard’s case is part of a state effort to improve care and reduce costs for the chronically ill. Under the approach, primary care doctors get extra money to put together teams, which might include nutritionists and behavior specialists, to treat people with illnesses such as diabetes, asthma and heart disease. They get bonuses if their patients show progress.

This coordinated approach, called "medical homes," is being tried in Pennsylvania, Wisconsin and Maryland and other states, and is a major issue in the health care overhaul being debated in Washington. President Barack Obama, Senate Finance Committee Chairman Max Baucus, D-Mont., and others have stressed the importance of treating chronic illnesses more effectively.

The reform legislation offered by House Democrats calls for Medicare and Medicaid to conduct pilot programs for reimbursing medical home projects. The Senate Health, Education, Labor and Pensions Committee legislation would provide grants for community health teams that would support a medical home model.

The goal is to begin shifting the health care system from one designed to respond to urgent episodes, such as heart attacks, strokes and broken bones, to one that provides better care for chronic conditions—or, better yet, prevents those problems.

The approach is showing promise. North Carolina and some other states say their efforts are saving money. And early data from the Vermont program—called Blueprint for Health—show that diabetes patients are achieving slightly better control of their blood glucose levels after just one year—an improvement health experts hope will translate into fewer costly complications.

Still, putting the programs in place on a national basis will not be easy. Inevitably, the programs touch on hot-button issues involving how doctors are paid and health care is organized and delivered. And what works for any individual state could very well flop for the nation. For example, Vermont, with only 623,000 people, is far less ethnically and economically diverse than many other states or the U.S. as a whole.

Improving chronic disease care also means changing ingrained patterns. Primary care and specialty physicians must figure out how to work together better and accept payment changes that reward them not for how much they do but for how healthy they manage to keep their patients. Patients need to work to prevent illnesses rather than just relying on doctors and pharmaceuticals for cures, according to experts.

There is ample evidence that better treatment is needed for chronic diseases, which are responsible for seven out of 10 deaths in the U.S., and eat up 75 percent of health care dollars, says the Centers for Disease Control and Prevention. Some 23.6 million Americans, or 8 percent of the population, have diabetes, and nearly two-thirds of those don’t have their disease under control, according to the American Diabetes Association.

Part of the problem: Many primary care physicians are ill-equipped to deal with chronic illnesses, experts say. When a patient is newly diagnosed, the doctor often takes 10 or 15 minutes to explain a complicated condition, talks up the benefits of a healthier lifestyle, maybe writes a prescription, and tells the patient to come back in three months.

Testing The Model In Vermont

In Vermont, the medical home concept is being tested in two Vermont communities--rural St. Johnsbury, where Dobbertin works, and urban Burlington. Physicians get state grants to put together chronic-care teams that focus on nutrition, exercise and behavioral health.

The goal is to allow doctors to provide services that usually aren't covered, says Elliott Fisher, director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.

Providers also get bonuses from insurers if the patients make progress according to national quality measures. “All providers in a practice have a stake in having a higher score,” says Dr. Craig Jones of the Vermont Department of Health.

Beyond that, providers in four other communities are focusing on diabetes prevention as a first step toward becoming full-fledged medical homes. The goal is to expand the medical-home concept across the state.

The Vermont program began in 2003 with just $145,000 from the state legislature. In 2006, the program became a part of the state’s comprehensive health overhaul, which is designed to ensure that 96 percent of residents have health insurance by 2010. The state's three major health insurers, Blue Cross-Blue Shield, MVP Health Care and Cigna, are required to help pay for the program. Last year, the total funding for the program was $4.8 million.

The team approach makes for a more gratifying job, says Dobbertin. “It’s no longer just me seeing patients appointment to appointment,” she adds, saying she acts as a quarterback, calling the shots but leaving the execution to others.

Physicians have always wanted to follow up with their patients, “but they don’t have the time or resources,” says Ken Thorpe, chairman of the department of health policy and management at Emory University and executive director of the Partnership to Prevent Chronic Disease, a coalition that focuses on the economic impact of chronic disease. Thorpe has worked for the state as a consultant on health care overhaul efforts.

But changing payment methods to funnel more money to primary care doctors raises sticky questions. “The long-term question needs to be asked: What is fair pay? What is a reasonable income?” says Fisher.

Some specialty care doctors may resist, says Hoangmai H. Pham, senior health researcher at the Center for Studying Health System Change, a nonpartisan research organization in Washington. “They’re concerned that eventually the money will have to come from somewhere, including their own reimbursement,” she says.

Figuring out exactly how to set up a medical home is a challenge as well. Physician groups can look for guidance to standards set by the National Committee for Quality Assurance, a Washington nonprofit that provides quality measures of health care organizations. But most of the guidelines have yet to show proven results, says Pham. And some aren’t clearly defined. Read more at www.kaiserhealthnews.org

Doctors can discern so much more from a home visit to a senior citizen or sick person by seeing their environment and asking more questions about nutrition, sanitation, socialization, and more.

Amplify’d from www.washingtonpost.com

New health-care law may prompt more people to come back home for medical care

By Michelle Andrews Tuesday, September 21, 2010

If you get sick at night or the weekend, all too often the local emergency room is the only medical facility with an open door. You may know that your regular doctor could treat your asthma or that nagging cough, but you wind up in the emergency room because your symptoms inconveniently occurred outside regular business hours.

A study this month in Health Affairs found that Americans bypass their primary-care doctor more than half the time when they have an acute problem. The study found that 28 percent of visits for acute care occurred in the emergency room between 2001 and 2004. Another 20 percent were handled by specialists.

When faced with potentially dangerous conditions such as chest pain or a high fever, going to the ER is the smartest move. But other acute problems -- such as a flare-up of a chronic condition or an upper respiratory infection -- could often be handled outside the ER if the patient's own doctor were available, researchers say.

"We have a health-care system that all too often expects patients to accommodate themselves to its needs rather than the other way around," says study co-author Arthur Kellermann of the Rand Corp., a nonprofit research group.

In some places, that has been changing. The Myrtue Medical Center's family practice clinic in Harlan, Iowa, is open until 7 p.m. on weekdays and on Saturday mornings as well. Ruth Neill's cousin drove her there one Saturday morning a few years ago when she became concerned because Neill, who is now 60, seemed disoriented. At the clinic, about 40 miles east of Neill's home in Mondamin, Iowa, her regular doctor was on duty. She whisked Neill into the examining room and in short order admitted her to the hospital. It turned out that Neill was disoriented because her oxygen levels were too low. Diagnosis: pneumonia.

Physicians are also becoming more accommodating in their scheduling. The number of primary-care physicians who offer same-day "open access" scheduling has grown to 62 percent, according to the American Academy of Family Practitioners, a substantial increase over the 29 percent who offered it in 2008. Still, only about a third of doctors said they offer evening or weekend appointments.

This is in stark contrast to other countries, where primary-care doctors are routinely available after hours. In a 2009 survey, 97 percent of primary-care practices in the Netherlands had arrangements for after-hours care by a doctor or nurse, according to the Commonwealth Fund. In the United Kingdom, the figure was 89 percent, and it was 78 percent in France.

Health-care experts and patient advocates point to a coordinated system of care as one of the options that can help ease the problem of finding a doctor outside regular work hours. The wider adoption of the "patient-centered medical home" model of primary care, like the clinic Neill visited, does just that.

The medical home model is an approach that harkens back to the days when family doctors were so familiar they almost seemed like part of the family. In today's medical home, a primary-care doctor leads a team responsible for coordinating and managing all of your care, whether it's making sure you're on top of routine lab tests to keep your diabetes in check or being available to handle unexpected problems, even during off hours. That coordination improves patient care and may help control costs, advocates say.

Embracing the medical home model generally requires physicians to retool their entire practices, rethinking how they schedule and communicate with patients, adding electronic medical records to better track patients and incorporating techniques to ensure that treatment is coordinated among primary-care doctors and specialists.

Improving patient access is critical to the success of medical homes. If you can't reach your doctor when you're sick, either to get in for an appointment or to chat by phone or e-mail, the physician can't coordinate your care.

Several provisions in the new health-care overhaul give a boost to the medical home model. The law provides for grants to create interdisciplinary community health teams to support patient-centered medical homes. It also provides grants to support networks to provide coordinated care to low-income patients. And it gives states the option of designating certain providers or groups of providers as health homes for Medicaid members with chronic conditions.

The law also requires the development of provider payment guidelines that reward the type of care provided in medical homes, such as care coordination and case management.

In the end, it may be up-and-coming doctors who provide a real incentive for practices to embrace the medical home model. At a recent conference for medical students, many were excited about the concept, says Lori Heim, president of the American Academy of Family Practitioners.

"They're looking for residencies that offer it, and they want to practice in that environment," she says. "I think it will be a recruiting tool." In that case, what makes doctors happy may be good for patients, too.

This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: questions@kaiserhealthnews.org. Read more at www.washingtonpost.com

Neighbors helping neighbors. Seniors helping seniors. The nuclear family has become radio-active. These senior villages are long overdue. Of the community, for the community, by the community!

Amplify’d from www.washingtonpost.com

Montgomery residents reach out to help others

By Cody Calamaio The Gazette Thursday, September 16, 2010

After Lois Levitan fell down an escalator at Washington Dulles International Airport and tore skin from her right hand, the usually dexterous sculptor was unable to take care of herself. She knew she needed a hand -- Somerset's Helping Hand to be exact.

Zola Schneider, founder of the volunteer neighbor assistance program, Somerset's Helping Hand, organized volunteers to dress the wound on Levitan's hand twice a day for two weeks while she waited for a skin graft.

Whether they are cleaning wounds, grocery shopping or providing rides to a doctor's office, Schneider and the Somerset program's 30 volunteers are there to help. The group, which Schneider founded in 2007, averages two or three calls per month from the town's 1,100 residents, as well as the occasional emergency.

"It is kind of a good-neighbor policy," said Schneider, who declined to give her age. She formed the group after a discussion with another resident about ways they could assist the community. Although it serves mostly older residents, the group is available to anyone in need.

Somerset's Helping Hand is one model of a community support organization that is helping older residents stay in their homes in what Montgomery County officials have identified as emerging, naturally occurring retirement communities, according to a county government report from last year. The report offered recommendations aimed at enhancing the County Council's understanding of how Montgomery is assisting such communities.

The communities occur when a large number senior citizens show a preference toward remaining in their homes as they age, instead of moving to a planned retirement community, the report says.

Residents 65 and older composed 12 percent of the county's population of 931,000 in 2005, and the number is expected to increase to 17 percent by 2030, the report says. The planning area with the largest senior population is Aspen Hill, with 20 percent of residents older than 65, followed by Bethesda and Chevy Chase, with 18 percent, and North Bethesda, with 17 percent.

Neighborly assistance organizations such as Somerset's Helping Hand have emerged, as have groups known as "villages," which usually provide a larger range of services. These can include social activities and medical assistance, and sometimes they charge a fee.

Neighborhoods in Bethesda, Rockville, Chevy Chase, Cabin John and Garrett Park either have established or intend to establish elderly-assistance programs, the report says.

Somerset's Helping Hand is a vital part of keeping older residents thriving in their homes because it goes beyond what the town can provide to care for people as they age, Somerset Mayor Jeffrey Slavin said.

In nearby Chevy Chase, a new "village" is emerging that seeks to provide a more complete scope of services to such residents.

Chevy Chase at Home, founded last year, received nonprofit status this summer and provides social opportunities such as book clubs and exercise programs to older residents, its president, Naomi Kaminsky, said. The group will expand to provide volunteer support services early next year.

About 350 people have expressed interest in becoming a member, and the program has received a $9,000 gift from the Town of Chevy Chase, said Kaminsky, 74, of the Town of Chevy Chase. Membership is limited to residents of Chevy Chase Village, the Town of Chevy Chase, the Village of Martin's Additions, Chevy Chase Section 3 and Chevy Chase Section 5.

Unlike those served by the Somerset group, residents seeking services from Chevy Chase at Home would pay an annual membership fee of about $250, Kaminsky said. Another membership category for purely social activities might be available at a lesser charge.

The membership fee will pay for expenses involving stage events and activities, as well as administrative costs for the group's office. Part of the money also would be used to sponsor seniors who can't afford to pay for their membership.

Paying for membership takes away the stigma of asking for help because many seniors are used to being self-sufficient and might not like to admit they need assistance, Kaminsky said.

Building a community in which people are not afraid to ask for help is the goal of Somerset's Helping Hand. Schneider organizes volunteers through e-mail, to protect the privacy of those seeking help.

Kaminsky said older residents need more than just rides and simple volunteer services; they need advice and help with life's large issues. Group members discussed moving toward a more formal "village" organization but decided they operated best as a neighbor-to-neighbor organization, Schneider said.

"This really is an opportunity to meet people you might have seen but not really spoken to, and I think that's really one of the rewards," Schneider said. "It's brought a lot of us together in a different way." Read more at www.washingtonpost.com

This is the new paradigm. What started in Boston and moved south is now moving west. If you've got stock in assisted living "chain stores" you might want to think about diversifying your eldercare holdings.

Amplify’d from articles.sfgate.com

Senior villages that help elderly stay at home come to West Coast

Cooperatives that help people stay in their homes come to the West Coast

December 12, 2007

By Robin Evans, Special to The Chronicle

The first "senior village" is open in the Bay Area, bringing to the West Coast a popular new model of care for the elderly. This village is not a place but a membership program that helps people stay in their own homes by providing support - everything from the medical to the mundane.

The concept was developed by a group of elderly neighbors in Boston trying to line up in-home services their insurance didn't cover.

"People end up moving because they can't change the lightbulbs or (they) get isolated when they get home from the hospital and can't coordinate everything," said Judy Willett, director of Beacon Hill Village in Boston, which opened five years ago. "The reason it's so popular is it's what everyone wants: to stay in their own homes. ... It's unbelievable the impact of such a brilliant and simple idea."

That simple idea is being developed in San Francisco by the Rev. Mary Moore Gaines, and is a reality at Avenidas Village in Palo Alto, which opened in October.

Mary Minkus, 74, a retired family law attorney in Palo Alto, was the force behind the village after she hurt her elbow five years ago and discovered what many seniors do: Her health insurance covered a nursing-home stay, but she didn't have coverage for the in-home help she'd need to stay at home during recovery.

For the first time in her adult life, the self-sufficient paraplegic couldn't lift herself from her wheelchair to her bed. She couldn't drive her specially equipped car and needed help dressing. What seemed at first like a nuisance had become a major obstacle, and she had a short stay in a nursing home.

"I was in the hospital for two weeks because I couldn't figure out how to do this," she said, referring to coordinating the cooking, cleaning, transportation and other daily tasks. "It changes your life."

The experience planted a seed. After hearing about the Boston village, she and some friends hooked up with Avenidas, a private nonprofit agency that has provided help and programs for seniors in the mid-Peninsula area for more than 35 years. It took almost two years, but the group developed the village program. In the past two months, it has signed up 187 members.

ccess to services that are often discounted for members: someone to cook, clean, do the laundry, fix the air

Here's how it works: Avenidas Village members pay an annual fee - singles pay $750, couples, $900. This buys them access to services that are often discounted for members: someone to cook, clean, do the laundry, fix the air conditioner, pick up groceries, make doctor's appointments, help them dress or get in and out of bed when they're laid up. It can even provide limited nursing care.

Members pay the providers, often from the community, but the village staff and volunteers select and screen them, and can help coordinate these appointments. Avenidas Village also provides a social outlet, linking people with similar interests. It's one phone call away. Minkus, who still serves on the advisory committee, hasn't yet felt the need to take advantage of the village services - although she does occasionally volunteer to help others. She regards her membership as a safety net. "Peace of mind is what goes with it, knowing someone is there to find answers for you at times you're not quite up to it or when it's faster and easier for someone to do it for you," she said. In San Francisco, Moore Gaines, the pastor of St. James Episcopal Church, has spent the past year working with seniors and organizations to bring a village for people 50 and older to her Richmond District neighborhood. She hopes to develop programs to connect people with the help they need to stay in their homes as they encounter the physical limitations of growing older and the loss of family and friends. She expects the village to open by the middle of next year. She also looked to Boston's Beacon Hill Village as a model and sees a silver lining for givers - from businesses to volunteers - as well as receivers: bringing back a sense of belonging. "It creates community is what it does," Moore Gaines said. "We're talking friendship and an appropriate level of intimacy and trust, where you would be willing to ask someone for something and they would be delighted to be asked." Retiring Boomers As the huge Baby Boom generation begins to retire, more people will be coming face to face with the demands of aging. By the year 2030, people 65 and older will make up 20 percent of the population (a growth of 104 percent over 2000), according to Census Bureau projections. In San Francisco, and the Bay Area, that figure is put at roughly 23 percent. "Every country is looking at large growth in the elder population and greater longevity," said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. "They're looking at quality of life and ways of prolonging the ability to live where we've always lived - and contain costs." Read more at articles.sfgate.com